Peritoneal dialysis fluid as a source of hepatitis antigen

An epidemic of HBsAg positive hepatitis involving the dialysis unit of the Seattle Veterans Administration Medical Center is described. 6 patients and 4 staff members were affected: there were four patient deaths. The source of HBsAg was identified as a chronic in-center peritoneal dialysis patient in whom both serum and peritoneal fluid were persistently HBsAg positive. Surveillance data documented heavy population exposure to HBsAg at the time of this patient's presence in the dialysis setting. We have subsequently identified 2 other patients with HBsAg positive peritoneal effluent. Peritoneal dialysis of HBsAg positive individuals represents a significant risk for the transmission of HBsAg and clinical hepatitis.